MassHealth Accountable Care Organizations (ACOs)

What is an ACO?

An ACO is a provider-led entity (e.g., a group of providers or a health system) that coordinates care, has an enhanced role for primary care, and is rewarded for value—improving total cost of care and outcomes—not volume. An ACO is expected to deliver a more integrated and improved member experience and have flexibility to engage members differently (e.g., enhanced services, care coordination).

What is the role of a health plan in an ACO?

The health plan (i.e., Fallon Health) pays claims and partners with the provider group to improve care delivery and to support integration of care. The partnership between the health plan and the provider group allows additional support, increased capacity, and improved analytics for population health management.

Which ACO Partnership Plans does Fallon participate in?

Fallon has partnered with hospitals, health care providers and community health centers across the state to create three ACO Partnership Plans to better serve MassHealth patients:

  • Berkshire Fallon Health Collaborative—a partnership with Berkshire Health Systems, Community Health Programs and several Berkshire County community physician practices. Learn more at fallonhealth.org/Berkshires.
  • Fallon 365 Care—a partnership with Reliant Medical Group and Southboro Medical Group. Learn more at fallonhealth.org/365care.
  • Wellforce Care Plan—a partnership with Wellforce, which is made up of physicians and other health care providers from, or affiliated with: Circle Health; Floating Hospital for Children at Tufts Medical Center; Hallmark Health; Lawrence Memorial Hospital of Medford; Lowell Community Health Center; Lowell General Hospital; Lowell General Physician Hospital Organization; Melrose-Wakefield Hospital; New England Quality Care Alliance (NEQCA); and Tufts Medical Center
    Learn more at fallonhealth.org/wellforce.